World’s smallest and lightest leadless pacemaker MICRA implanted at Fortis Malar Hospital

Doctors at Fortis Malar Hospital successfully implanted the world’s smallest and lightest leadless pacemaker MICRA on a 31-year lady here recently. The patient was suffering from Complex Congenital Heart Disease and Altered Cardiovascular Anatomy.  The challenging procedure was conducted by a team of expert doctors led by Dr. E. Babu, Consultant Heart Failure & Interventional Cardiologist, Fortis Malar Hospital, Chennai.

Commenting on the procedure, Dr. E. Babu, said, “This procedure was particularly challenging due to the altered anatomy and septal defects. The uniqueness of this case is MICRA catheter has been manipulated via transfemoral approach and deployed successfully in RV septum in this underweight patient with Complex Congenital Heart Disease.”

The patient was diagnosed with Complex Cyanotic Congenital Heart Disease (Complete Atrioventricular Canal Defect with Eisenmenger Syndrome), and later developed Atrial Tachyarrhythmia and complete heart block with the low ventricular rate. After discussion with Dr. K. R. Balakrishnan, Director of Cardiac Sciences and Chief Cardiothoracic & Transplant Surgeon at Fortis Malar Hospital, she was deemed not suitable for corrective surgery and was advised Single Chamber Permanent Pacemaker Implantation. Eventually, MICRA leadless pacemaker was decided for this patient.

Dr. E. Babu added, “The function of a pacemaker is to increase the heart rate when it is low. The conventional pacemaker has to two parts, namely the pulse generator (generator) and the lead. This pulse generator is implanted beneath the skin in the upper chest wall through a mini surgical procedure and a long lead connects it to heart. This requires 3-7 days of hospital stay, removal of stitches after 1 week and may be associated with issues of infection, wound healing, etc. On the other hand, MICRA pacemaker procedure is a percutaneous procedure just like undergoing angiography. It is cosmetically good because there is no scar in the chest wall. The patient can be mobilised on the same day and the procedure may be performed as a day-care procedure in straightforward cases.”

MICRA pacemaker is the world’s smallest and lightest leadless cardiac pacemaker currently available. It is delivered percutaneously via transfemoral venous approach through a catheter and implanted directly in the right ventricle. MICRA is a single chamber pacemaker; it is the pulse generator and does not require the use of leads. MICRA is 93% smaller (25.9x6.7mm) and also lighter (1.75g) than a conventional pacemaker, with average battery longevity of 12-years and MRI compatibility. It is just the size of a large tablet/capsule. It has >99% higher implant success rate and 63% fewer long-term complications (primarily) than a conventional pacemaker.